PDL CLASS Preferred Drugs Non-Preferred Drugs

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ANTI-INFECTIVES: Antifungals for Onychomycosis Griseofulvin Susp Terbinafine Tabs Griseofulvin Caps/Tabs Griseofulvin Micro/Ultramicrosize Tabs Gris-PEG® Itraconazole Onmel® Sporanox® March/April ANTI-INFECTIVES: Antifungals for Thrush Clotrimazole Troche Fluconazole Susp/Tabs Nystatin Susp/Tabs Diflucan® Nystatin Oral Pwd

Oravig® Buccal March/April

ANTI-INFECTIVES: Fluoroquinolones, Oral Ciprofloxacin Tabs Levofloxacin Tabs Baxdela™ Cipro® Cipro XR® Ciprofloxacin Susp Ciprofloxacin ER Levofloxacin Soln Moxifloxacin Ofloxacin June/July ANTI-INFECTIVES: GI Antibiotics Metronidazole Tabs Neomycin Vancomycin Caps Alinia® Dificid® Firvanq® Flagyl® Metronidazole Caps Nitazoxanide Tabs Paromomycin Tinidazole Vancocin® Vancomycin Soln Xifaxan® June/July ANTI-INFECTIVES: Hepatitis C Agents,

Oral Direct Acting Antivirals

Epclusa® Mavyret® Sofosbuvir-Velpatasvir Vosevi® (Retreatment Only)

Harvoni® Ledipasvir-Sofosbuvir Sovaldi® Viekira Pak™ Zepatier® June/July ANTI-INFECTIVES: Inhaled Antibiotics Bethkis® Kitabis® Pak TOBI Podhaler® Tobramycin Amp (gen

TOBI®)

Arikayce® Cayston® TOBI®

Tobramycin Amp (gen Bethkis®) Tobramycin Pak (gen Kitabis®

Pak) March/April ANTI-INFECTIVES: Antivirals, General Acyclovir Caps/Susp/Tabs Valacyclovir Famciclovir Valtrex® Zovirax® Caps/Susp/Tabs March/April ANTI-INFECTIVES: Vaginal Antibiotics

Cleocin® Vaginal Ovules Clindesse® Nuvessa™ Vaginal Gel Vandazole® Vaginal Gel

Cleocin® Vaginal Crm Clindamycin Vaginal Crm

MetroGel Vaginal® Gel Metronidazole Vaginal Gel

Solosec®

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ANTI-INFECTIVES: Cephalosporins, 1st Generation Cefadroxil Caps Cephalexin Caps/Susp Cefadroxil Tabs/Susp Cephalexin Tabs Keflex® June/July ANTI-INFECTIVES: Cephalosporins, 2nd Generation Cefprozil Tabs/Susp Cefuroxime Tabs Cefaclor Caps/Susp

Cefaclor ER Tabs June/July

ANTI-INFECTIVES: Cephalosporins, 3rd

Generation

Cefdinir Caps/Susp Cefixime Caps/Susp Cefpodoxime Tabs/Susp Suprax® June/July ANTI-INFECTIVES: Macrolides Azithromycin Tabs/Susp Clarithromycin Tabs/Susp Erythromycin Base DR Caps

Erythromycin Ethylsuccinate Tabs/Susp Clarithromycin ER E.E.S. 200® Susp E.E.S. 400® ERYC® EryPed® Ery-Tab® Erythrocin® Stearate Erythromycin Base Tabs Erythromycin Base DR Tabs

Erythromycin ES Tabs PCE® Zithromax® June/July ANTI-INFECTIVES: Penicillins Amoxicillin Amox/Clav Susp/Tabs (except 250-62.5mg/5mL Susp) Ampicillin Bicillin® C-R Inj Penicillin V Amox/Clav 250-62.5mg/5mL Susp

Amox/Clav Chew Tabs Amox/Clav XR Tabs Augmentin XR® Augmentin® Susp Dicloxacillin June/July ANTI-INFECTIVES: Tetracyclines

Doxycycline Hyclate Caps Doxycycline Hyclate Tabs

(gen Vibra-Tabs®, Periostat®) Doxycycline Mono Susp

Minocycline Caps Amzeeq® Avidoxy Avidoxy DK Benzodox™ Demeclocycline Doryx® Doryx® MPC

Doxycycline Hyclate Tabs (gen Acticlate®)

Doxycycline Hyclate DR Doxycycline Mono Caps/Tabs

Doxycycline Mono IR-DR Minocin® Minocycline ER Minocycline Tabs Minolira™ Mondoxyne™ NL Morgidox® Nuzyra® June/July

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Oracea® Solodyn® Tetracycline Vibramycin® Xerava™ Ximino® Zilxi® CARDIOVASCULAR: Angiotensin Converting Enzyme Inhibitors (ACEIs) Benazepril Enalapril Fosinopril Lisinopril Quinapril Ramipril Accupril® Altace® Captopril Epaned® Lotensin® Moexipril Perindopril Prinivil® Qbrelis® Trandolapril Univasc® Vasotec® Zestril® Sept/Oct CARDIOVASCULAR: ACE Inhibitors/Diuretic Combination Agents Benazepril/HCTZ Enalapril/HCTZ Lisinopril/HCTZ Accuretic® Captopril/HCTZ Fosinopril/HCTZ Lotensin HCT® Moexipril/HCTZ Quinapril/HCTZ Vaseretic® Zestoretic® Sept/Oct CARDIOVASCULAR: ACE Inhibitors/Calcium Channel Blocker Combination Agents Amlodipine/Benazepril Trandolapril/Verapamil Lotrel® Tarka® Sept/Oct CARDIOVASCULAR: Angiotensin Receptor Blockers (ARBs) Irbesartan Losartan Telmisartan Valsartan Atacand® Avapro® Benicar® Candesartan Cozaar® Diovan® Edarbi® Eprosartan Micardis® Olmesartan Sept/Oct CARDIOVASCULAR: Angiotensin Receptor Blocker/Diuretic Combination Agents Irbesartan/HCTZ Losartan/ HCTZ Telmisartan/HCTZ Valsartan/HCTZ Atacand HCT® Avalide® Benicar HCT® Candesartan/HCTZ Diovan HCT® Sept/Oct

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Edarbyclor® Hyzaar® Micardis HCT® Olmesartan/HCTZ CARDIOVASCULAR: Angiotensin Receptor/Calcium Channel Blocker Combination Agents Valsartan/Amlodipine Azor® Exforge® Olmesartan/Amlodipine Telmisartan/Amlodipine Twynsta® Sept/Oct CARDIOVASCULAR: Angiotensin Receptor/Calcium Channel Blocker/ Thiazide Combination Agents Exforge® HCT Olmesartan/Amlodipine/HCTZ Tribenzor® Valsartan/Amlodipine/HCTZ Sept/Oct CARDIOVASCULAR: Anticoagulants, Oral Eliquis® Pradaxa® Warfarin Xarelto® 10, 15, 20mg

Xarelto® Starter Pack

Bevyxxa® Coumadin® Jantoven® Savaysa® Xarelto® 2.5 mg Sept/Oct CARDIOVASCULAR: Anticoagulants, Injectables Enoxaparin Fragmin® Arixtra® Fondaparinux Lovenox® Sept/Oct CARDIOVASCULAR: Antiplatelets Aspirin/Dipyridamole Brilinta® Clopidogrel Dipyridamole Prasugrel Aggrenox® Aspirin/Omeprazole Cilostazol Effient® Plavix® Yosprala® Zontivity® Sept/Oct CARDIOVASCULAR: Beta-Blockers Acebutolol Atenolol Bisoprolol Carvedilol Hemangeol® Labetalol Metoprolol Succinate Metoprolol Tartrate Nadolol Propranolol HCl Propranolol Soln Sorine® Sotalol Sotalol AF Betapace® Betapace AF® Betaxolol Bystolic® Carvedilol ER Coreg® Coreg CR® Corgard® Inderal LA® Inderal XL® InnoPran XL® Kapspargo® Sprinkle Caps

Lopressor Pindolol Propranolol ER/LA Sotylize® Tenormin® Sept/Oct

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Timolol Maleate Toprol XL® CARDIOVASCULAR: Beta-Blocker/ Diuretic Combination Agents Atenolol/Chlorthalidone Bisoprolol/HCTZ Metoprolol/HCTZ Propranolol/HCTZ Dutoprol® Lopressor HCT® Metoprolol ER/HCTZ Nadolol/Bendroflumethiazide Tenoretic® Ziac® Sept/Oct CARDIOVASCULAR: Calcium Channel Blockers, Dihydropyridines Amlodipine Felodipine ER Nifedipine ER Nifedipine IR Adalat CC® Afeditab CR® Isradipine Katerzia™ Nicardipine Nifedical XL Nimodipine Nisoldipine ER Norvasc® Nymalize® Procardia® Procardia XL® Sular® Sept/Oct CARDIOVASCULAR: Calcium Channel Blockers, Non-Dihydropyridines Cartia XT® Dilt-XR Diltiazem CD Diltiazem ER Caps Diltiazem HCl Diltiazem XR Taztia XT® Verapamil HCl Verapamil ER Caps/Tabs Verapamil SR Calan® Calan SR® Cardizem Cardizem CD® Cardizem LA® Diltiazem LA Tabs Matzim LA® Tiadylt® ER Tiazac® Verapamil ER PM Verelan® Verelan PM® Sept/Oct CARDIOVASCULAR: Direct Renin Inhibitors & Combination Agents Aliskiren Tekturna HCT® Tekturna® Sept/Oct CARDIOVASCULAR: Lipotropics, Homozygous Familial Hypercholesterol-emia (HoFH) Agents

Evkeeza™ Juxtapid® Sept/Oct CARDIOVASCULAR: Lipotropics, Niacin Derivatives Niacor Niacin ER Niacin IR Niaspan® Sept/Oct

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CARDIOVASCULAR: Lipotropics, PCSK9

Inhibitors

Repatha® (Amgen USA Mft) Praluent®

Sept/Oct CARDIOVASCULAR: Lipotropics, Statins (HMG-CoA Reductase Inhibitors) & Combination Agents Atorvastatin Lovastatin Pravastatin Rosuvastatin Simvastatin Altoprev® Amlodipine/Atorvastatin Caduet® Crestor® Ezallor ™ Sprinkle Ezetimibe Ezetimibe/Simvastatin FloLipid Fluvastatin Fluvastatin ER Lescol XL® Lipitor® Livalo® Nexletol™ Nexlizet™ Pravachol® Vytorin® Zetia® Zocor® Zypitamag ™ Sept/Oct CARDIOVASCULAR: Lipotropics, Triglyceride Lowering Agents Fenofibrate 54, 67, 134, 160, 200mg (gen Lofibra®) Fenofibrate 48, 145mg (gen Tricor®) Gemfibrozil Antara®

Fenofibrate (gen Antara®) Fenofibrate (gen Fenoglide®)

Fenofibrate (gen Lipofen®) Fenofibrate (gen Triglide®) Fenofibric Acid (gen Fibricor®)

Fenofibric Acid (gen Trilipix®) Fenoglide®

Fibricor®

Icosapent Ethyl (gen Vascepa®) Lipofen®

Lofibra® Lopid® Lovaza®

Omega-3 Acid Ethyl Esters Tricor® Triglide® Triklo Trilipix® Vascepa® Sept/Oct CARDIOVASCULAR: Sympatholytic Agents Catapres-TTS® Patch Clonidine Tabs Guanfacine Methyldopa Catapres® Tabs Clonidine Patch Lucemyra® Methyldopa/HCTZ Sept/Oct

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CENTRAL NERVOUS SYSTEM: ADHD, Amphetamine like, Long Acting Adderall XR® Vyvanse® Caps Vyvanse® Chew Tabs

Adzenys ER™ Susp Adzenys XR ODT™ Amphetamine ER Susp (gen

Adzenys ER™) Dexedrine® Spansule Dextroamphetamine ER Dextroamphetamine/Ampheta

mine ER (gen Adderall XR®) Dyanavel® XR Susp Mydayis® ER Caps Sept/Oct CENTRAL NERVOUS SYSTEM: ADHD, Amphetamine like, Short Acting Dextroamphetamine Tabs Dextroamphetamine/ Amphetamine Adderall®

Amphetamine Sulfate Tabs (gen Evekeo®)

Desoxyn® Tabs Dextroamphetamine Soln

Evekeo® Methamphetamine Tabs Procentra® Soln (Brand preferred

over generic) Zenzedi® Sept/Oct CENTRAL NERVOUS SYSTEM: ADHD, Methylphenidate, Long Acting Concerta® Daytrana® Focalin XR® Metadate® ER Methylphenidate CD Methylphenidate LA Methylphenidate SR Quillichew ER® Quillivant XR® Adhansia XR™ Aptensio XR™ Cotempla XR ODT™ Dexmethylphenidate XR Jornay PM™ Metadate CD® Methylphenidate ER Caps (gen

Aptensio XR™) Methylphenidate ER Tabs (gen

Concerta®)

Methylphenidate ER 72 mg Tabs (gen Relexxii™ ER Tabs)

Relexxii™ ER Tabs Ritalin LA® Sept/Oct CENTRAL NERVOUS SYSTEM: ADHD, Methylphenidate, Short Acting Dexmethylphenidate Methylphenidate Soln/Tabs Focalin® Methylphenidate Chew Methylin® Ritalin® Sept/Oct CENTRAL NERVOUS SYSTEM: ADHD,

Non-Stimulants Atomoxetine Clonidine ER Guanfacine ER Intuniv® Kapvay™ Qelbree™ Strattera® Sept/Oct CENTRAL NERVOUS SYSTEM: Agents for

Alzheimers, Cholinesterase Inhibitors Donepezil ODT Donepezil 5, 10 mg Tabs Exelon® Patch Memantine Tabs Aricept® Donepezil 23 mg Tabs Galantamine Soln/Tabs Galantamine ER Memantine Soln Memantine ER Namenda® Dec/Jan

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Namenda XR® Namzaric® Razadyne® Razadyne ER® Rivastigmine CENTRAL NERVOUS SYSTEM: Anti-Parkinsonism Agents, Monoamine Oxidase B Inhibitors Selegiline Azilect® Rasagiline Xadago® Zelapar® Dec/Jan CENTRAL NERVOUS SYSTEM: Anti-Parkinsonism Agents, Non-Ergot Dopamine Agonists Amantadine Pramipexole Ropinirole Apokyn® Gocovri® Kynmobi™ Mirapex® Mirapex ER® Neupro® Osmolex® ER Pramipexole ER Requip® Requip XL® Ropinirole ER Dec/Jan CENTRAL NERVOUS SYSTEM: Analgesics, NSAIDS Celecoxib Diclofenac 1% Gel OTC Diclofenac Sodium DR/EC

Tabs Ibuprofen Ketorolac Inj/Tabs

Meloxicam Tabs Naproxen OTC Naproxen Tabs Rx (gen

Naprosyn®) Arthrotec® Cambia® Celebrex® Daypro® Diclofenac 1% Gel Rx Diclofenac 1.3% Patch (gen

Flector®)

Diclofenac 1.5% Topical Soln Diclofenac Caps (gen Zorvolex®)

Diclofenac Potassium Diclofenac Sodium ER (gen

Voltaren® XR) Diclofenac/Misoprostol Diflunisal Duexis® Etodolac Etodolac ER Feldene® Fenoprofen Flector® Patch Flurbiprofen Indocin® Indomethacin Indomethacin ER Ketoprofen Ketoprofen ER Ketorolac Nasal Spray

Licart™

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Meclofenamate Mefenamic Acid Meloxicam Caps Mobic® Nabumetone Nalfon® Naprelan® Naprosyn®

Naproxen CR (gen Naprelan®) Naproxen DS (gen Anaprox® DS)

Naproxen EC (gen Naprosyn® EC)

Naproxen Sodium (gen Anaprox®) Naproxen Susp Naproxen/Esomeprazole Oxaprozin Pennsaid® Piroxicam Qmiiz™ ODT Relafen™ DS Sprix® Sulindac Tivorbex® Tolmetin Vimovo® Vivlodex® Voltaren® Zipsor® Zorvolex® CENTRAL NERVOUS SYSTEM: Analgesics, Opioids, Long-Acting Narcotics Butrans® Fentanyl Patch 12, 25, 50, 75, 100mcg/hr Morphine Sulfate ER Tabs

(gen MS Contin®) Arymo® ER Belbuca® Buprenorphine Patch Duragesic® Fentanyl Patch 37.5, 62.5, 87.5mcg/hr

Hydrocodone ER (gen Hysingla™ ER and Zohydro® ER)

Hydromorphone ER Hysingla™ ER

Kadian®

Morphine ER Caps (gen Avinza®) Morphine ER Caps (gen Kadian®)

MS Contin® Oxycodone ER OxyContin® Oxymorphone ER Xtampza ER® Zohydro® ER Dec/Jan

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CENTRAL NERVOUS SYSTEM: Analgesics, Opiate Dependence Agents Buprenorphine SL Tabs Buprenorphine/Naloxone SL Tabs Naltrexone Tabs Sublocade™ Suboxone® Film Vivitrol® Bunavail® Buprenorphine/Naloxone SL Film Probuphine® Zubsolv® Dec/Jan CENTRAL NERVOUS SYSTEM: Analgesics, Opiate Emergency Reversal Agents Naloxone Narcan® Dec/Jan CENTRAL NERVOUS SYSTEM: Analgesics, Tramadol Like Agents

Tramadol 50mg (gen Ultram®) Tramadol ER Tabs (gen

Ultram® ER) Tramadol/APAP ConZip® Nucynta® Nucynta® ER Qdolo™ Tramadol 100 mg Tramadol ER Caps (gen ConZip®)

Tramadol ER Tabs (gen Ryzolt™) Ultracet® Ultram® Dec/Jan CENTRAL NERVOUS SYSTEM: Analgesics, Fibromyalgia Agents Duloxetine 20, 30, 60 mg Pregabalin Caps Cymbalta® Drizalma Sprinkle™ Duloxetine 40 mg Lyrica® Lyrica® CR Pregabalin ER Tabs/Soln Savella® Dec/Jan CENTRAL NERVOUS SYSTEM: Analgesics, Neuropathic Pain Agents Gabapentin Caps/Tabs Lidocaine 5% Patch Gabapentin Soln Gralise® Horizant® Lidoderm® Neurontin® Qutenza® Ztlido® Dec/Jan CENTRAL NERVOUS SYSTEM: Anticonvulsants, Dravet Syndrome Epidiolex® Diacomit® Fintepla® Dec/Jan CENTRAL NERVOUS SYSTEM: Anticonvulsants, Rescue Agents Diazepam Rectal Valtoco® Diastat® Nayzilam® Sept/Oct CENTRAL NERVOUS SYSTEM: Anti-Migraine, Alternative Oral Agents Nurtec™ ODT Ubrelvy® Reyvow® Dec/Jan

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CENTRAL NERVOUS SYSTEM: Calcitonin Gene-Related Peptide (CGRP) Receptors Ajovy® Emgality® 120mg/mL Aimovig® Emgality® 100mg/mL Vyepti™ Dec/Jan CENTRAL NERVOUS SYSTEM: Anti-Migraine, Serotonin (5-HT1) Receptor Agonists Rizatriptan Sumatriptan Almotriptan Amerge® Eletriptan Frova® Frovatriptan Imitrex® Maxalt® Maxalt-MLT® Naratriptan Onzetra® Xsail® Relpax® Sumatriptan/Naproxen Tosymra™ Treximet® Zembrace® Symtouch® Zolmitriptan Zomig® Zomig-ZMT® Dec/Jan CENTRAL NERVOUS SYSTEM: Multiple Sclerosis, Injectable Agents Avonex® Betaseron® Kit/Vial Copaxone® 20 mg Syringe Rebif ® Rebif® Rebidose® Copaxone® 40 mg Syringe Extavia® Glatiramer Glatopa® Kesimpta® Lemtrada® Ocrevus® Plegridy® Tysabri® June/July CENTRAL NERVOUS SYSTEM: Multiple Sclerosis, Oral Agents

Aubagio®** Dimethyl fumarate** Gilenya®** Bafiertam™ Mavenclad® Mayzent® Ponvory™ Tecfidera® Vumerity™ Zeposia® June/July

**Pending trial of one injectable agent

CENTRAL NERVOUS SYSTEM: Sedative Hypnotics, Benzodiazepines Temazepam 15, 30 mg Estazolam Flurazepam Halcion® Midazolam Syrup Restoril™ Temazepam 7.5, 22.5 mg Triazolam Dec/Jan

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CENTRAL NERVOUS SYSTEM: Sedative Hypnotics, Non-Benzodiazepines Doxepin 10, 25, 50, 75, 100, 150 mg Caps Eszopiclone Zaleplon Zolpidem Tabs Ambien® Ambien CR® Belsomra® Dayvigo™ Doxepin 3, 6 mg Tabs Edluar® Intermezzo® Lunesta® Silenor® Zolpidem ER Zolpidem SL Dec/Jan CENTRAL NERVOUS SYSTEM: Sedative Hypnotics, Non-Benzodiazepines, Melatonin Receptor Agonists Hetlioz® Ramelteon Rozerem® Dec/Jan CENTRAL NERVOUS SYSTEM: Skeletal Muscle Relaxants Baclofen Chlorzoxazone 250, 500mg Cyclobenzaprine Tabs (gen

Flexeril®) Dantrolene Methocarbamol Orphenadrine ER Tizanidine Tabs Amrix® Carisoprodol Carisoprodol/ASA Carisoprodol/ASA/Codeine Chlorzoxazone 375, 750 mg Cyclobenzaprine 7.5 mg Tabs (gen Fexmid®) Cyclobenzaprine ER Dantrium® Fexmid® Lorzone® Metaxalone Norgesic Forte Orphenadrine/ASA/Caffeine Orphengesic® Forte Ozobax® Robaxin® Skelaxin® Soma® Tizanidine Caps Zanaflex® Dec/Jan CENTRAL NERVOUS SYSTEM: Spinal Muscular Atrophy Agents Zolgensma® Sept/Oct CENTRAL NERVOUS SYSTEM: Vesicular Monoamine Austedo® Tetrabenazine Ingrezza® Xenazine® Dec/Jan

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Transporter 2 (VMAT2) Inhibitors CENTRAL NERVOUS SYSTEM: MISC Zulresso™ March/April DERMATOLOGIC

AGENTS: Oral Agents for Psoriasis Acitretin Methoxsalen Oxsoralen-Ultra® Soriatane® March/April DERMATOLOGIC AGENTS: Topical Agents for Psoriasis

Calcipotriene Soln Dovonex® Vectical® Calcipotriene Crm/Foam/Oint Calcipotriene/Betamethasone Calcitrene® Calcitriol Duobrii® Enstilar® Sorilux® Taclonex® March/April DERMATOLOGIC AGENTS: Topical Agents for Actinic

Keratosis Fluorouracil 5% Crm (gen Efudex®) Fluorouracil Soln Imiquimod 5% (gen Aldara®) Aldara® Carac® Diclofenac 3% Gel Efudex® Fluorouracil 0.5% Crm (gen Carac®)

Imiquimod 3.75% (gen Zyclara®) Picato® Solaraze® Tolak® Zyclara® March/April DERMATOLOGIC AGENTS: Topical Antibiotic/Benzoyl Peroxide Clindamycin/Benzoyl Peroxide 1.2%/5% (gen Duac®) Acanya® BenzaClin® BenzaClin® w/Pump Benzamycin® Clindamycin/Benzoyl Peroxide 1.2%/2.5% (gen Acanya® Gel

Pump)

Clindamycin/Benzoyl Peroxide 1%/5% (gen BenzaClin®) Clindamycin/Benzoyl Peroxide Pump 1%/5% (gen BenzaClin®

w/Pump) Erythromycin/Benzoyl Peroxide (gen Benzamycin®) Neuac® Onexton® March/April DERMATOLOGIC AGENTS: Topical Antifungals Butenafine Crm OTC Ciclopirox 0.77% Crm/Susp Clotrimazole Crm/Soln OTC

Clotrimazole/ Betamethasone Crm

Alevazol® OTC Azolen™ Tinc OTC

CicloDan® Ciclopirox 0.77% Gel Ciclopirox 1% Shampoo

Ciclopirox 8% Kit/Soln

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Ketoconazole Shampoo Miconazole Crm/Pwd OTC Nyamyc® Pwd Nystatin Crm/Oint/Pwd Nystop® Pwd Terbinafine Crm OTC Tolnaftate Crm/Soln OTC

Zeasorb® AF Clotrimazole Crm/Soln Rx Clotrimazole/Betamethasone Lot Desenex® Econazole Ertaczo® Exelderm® Extina® Fungoid®-D Jublia® Kerydin® Ketoconazole Crm/Foam Ketodan® Lamisil® Spray OTC

Loprox® Lotrimin® Lotrisone® Luliconazole Luzu® Mentax® Miconazole Spray OTC Miconazole-Zinc-Petro 0.25-15% Naftifine Naftin® Nizoral® Nizoral® A-D Nystatin/Triamcinolone Oxiconazole Oxistat® Penlac® Tavaborole Tinactin® Tolnaftate Pwd/Spray OTC

Vusion® Xolegel®

DERMATOLOGIC AGENTS: Topical Antiparasitics, Treatment of Lice &

Scabies Lycelle® OTC Natroba™ Permethrin OTC/Rx Crm Piperonyl butoxide/Pyrethrin (gen

Rid® Shampoo OTC) Piperonyl butoxide/ Pyrethrin/Permethrin (gen Rid® Lice Complete Kit OTC)

Crotan™ Elimite™ Eurax® Ivermectin Lot Rx Lindane Malathion Lot Ovide® Sklice® Spinosad Ulesfia® VanaLice™ OTC Gel

March/April DERMATOLOGIC AGENTS: Topical Antivirals Docosanol Zovirax® Crm Abreva® OTC Acyclovir Crm/Oint Denavir® March/April

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Sitavig® Xerese® Zovirax® Oint DERMATOLOGIC AGENTS: Topical Corticosteroids Anusol-HC™ Betamethasone Dip Lot

Betamethasone Val Crm/Lot/Oint Clobetasol Emollient Crm Clobetasol Prop Crm/Gel/Oint/Soln Diflorasone Oint Fluticasone Prop Crm/Oint

Hydrocortisone Crm/Lot/Oint Rx Hydrocortisone Crm/Oint OTC Mometasone Procto-Med HC™ Proctosol-HC® Proctozone-HC® Triamcinolone Crm/Lot/Oint (excluding gen Trianex®) Ala-Scalp® Alclometasone Dip Amcinonide Apexicon E® Aqua Glycolic® HC Kit

Beser™ Betamethasone AF Crm Betamethasone Dip Aug

Crm/Gel/Lot/Oint Betamethasone Dip Crm/Oint

Betamethasone Val Foam Bryhali®

Capex®

Clobetasol Emollient Foam Clobetasol Prop Foam/Lot/Shampoo/Spray Clobetavix Kit Clobex® Clocortolone Clodan® Cloderm® Cordran® Cutivate® Derma-Smoothe/FS® Dermatop® Desonate® Desonide Desowen® Desoximetasone Diflorasone Crm Diprolene® Elocon® Fluocinolone Fluocinonide Fluocinonide Emollient Flurandrenolide Fluticasone Prop Lot

Halcinonide Halobetasol

Halog®

Hydrocortisone Absorbase Rx Hydrocortisone Butyrate

Hydrocortisone Lot OTC Hydrocortisone Valerate Hydrocortisone/Aloe

Impeklo™

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Impoyz™ Kenalog® Lexette™ Locoid® Locoid Lipocream® Luxiq® Micort-HC® Nolix® Nucort™ Olux® Olux-E® Pandel® Pediaderm™ Prednicarbate Procto-Pak™ Psorcon® Scalpicin® Sernivo® Synalar® Temovate® Texacort™ Topicort® Tovet™

Triamcinolone 0.05% Oint (gen Trianex®)

Triamcinolone Acet Aerosol Trianex® Triderm™ Tridesilon® Ultravate® Ultravate® X Vanos® Verdeso® DERMATOLOGIC AGENTS: Atopic Dermatitis Elidel® Eucrisa® Pimecrolimus Protopic® Tacrolimus March/April DERMATOLOGIC AGENTS: Topical Retinoid Agents Differin® 0.1% Crm/Lot Rx Differin® 0.3% Gel Pump Rx

Retin-A® Crm/Gel Tazorac® Gel Adapalene 0.1% Adapalene 0.3% Adapalene/Benzoyl Peroxide Aklief® Altreno® Arazlo™ Atralin® Clindamycin/Tretinoin Differin® 0.1% Gel OTC/Rx

Differin® 0.3% Gel Rx Epiduo® Epiduo® Forte

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Fabior®

Retin-A® Micro® Gel/Pump Tazarotene Tazorac® Crm Tretinoin Crm/Gel Tretinoin Micro Gel

Tretin-X® Veltin® Ziana® ENDOCRINE AND METABOLIC AGENTS: Androgenic Agents

Androderm® Gel Patch Testosterone Cypionate Testosterone Enanthate Testosterone 1.62% Pump (gen AndroGel® 1.62% Pump) Anadrol®-50 AndroGel® Android® Aveed® Depo®-Testosterone Fortesta® Jatenzo® Methitest™ Tabs Methyltestosterone Caps Natesto® Striant® Testim® Testopel®

Testosterone 1% Pump (gen AndroGel®)

Testosterone Gel (gen Fortesta®)

Testosterone Gel Pack (gen AndroGel® Pack) Testosterone Gel Pump (gen

Axiron®)

Testosterone Transderm (gen Testim®) Testred® Vogelxo® Xyosted® March/April ENDOCRINE AND METABOLIC AGENTS: Antihyperglycemic, Amylin-Analogs Symlin Pen® June/July ENDOCRINE AND METABOLIC AGENTS: Antihyperglycemic, GLP-1 Receptor Agonist Bydureon® Byetta® Victoza® Adlyxin™

Bydureon Bcise® Auto-Injector Ozempic® Rybelsus® Soliqua® Trulicity® Xultophy® June/July

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ENDOCRINE AND METABOLIC AGENTS: Antihyperglycemic, Alpha Glucosidase Inhibitor Acarbose Miglitol Glyset® Precose® June/July ENDOCRINE AND METABOLIC AGENTS: Antihyperglycemic, Meglitinide Nateglinide Repaglinide Prandin® Starlix® June/July ENDOCRINE AND METABOLIC AGENTS: Antihyperglycemic, Biguanide & Combination Agents Glipizide/Metformin Glyburide/Metformin Metformin HCl Metformin ER (gen Glucophage® XR) Fortamet® Glucophage® Glucophage® XR Glumetza®

Metformin ER (gen Fortamet® OSM)

Metformin ER (gen Glumetza® MOD) Metformin Soln Repaglinide/Metformin Riomet® Riomet ER™ June/July ENDOCRINE AND METABOLIC AGENTS: Antihyperglycemic, DPP-IV (Dipeptidyl Peptidase-4) Inhibitors & Combination Agents Janumet® Janumet® XR Januvia® Jentadueto® Kombiglyze® XR Onglyza® Tradjenta® Alogliptin Alogliptin/Metformin Alogliptin/Pioglitazone Glyxambi® Jentadueto® XR Kazano Nesina™ Oseni Qtern® Steglujan™ June/July ENDOCRINE AND METABOLIC AGENTS: Antihyperglycemic, SGLT2-Inhibitors & Combination Agents Farxiga® Invokana® Jardiance® Synjardy® Invokamet® Invokamet XR® Segluromet™ Steglatro™ Synjardy® XR Trijardy® XR Xigduo® XR June/July ENDOCRINE AND METABOLIC AGENTS: Antihyperglycemic, Thiazolidinediones (TZDs) & Combination Agents Pioglitazone Actos® ActosplusMet® Avandia® Duetact® Pioglitazone/Glimepiride Pioglitazone/Metformin June/July

(19)

ENDOCRINE AND METABOLIC AGENTS:

Agents for Bone Ossification, Bisphosphonates Alendronate Tabs Ibandronate Tabs Actonel® Alendronate Soln Atelvia® Binosto® Boniva® Etidronate Fosamax® Fosamax Plus D® Risedronate Risedronate DR June/July ENDOCRINE AND METABOLIC AGENTS:

Agents for Bone Ossification, Calcitonin Agents

Calcitonin Salmon Nasal Spray

June/July

ENDOCRINE AND METABOLIC AGENTS:

Growth Hormones & Growth Hormone Releasing Factors, Select Agents Egrifta SV™ Increlex® Egrifta® June/July ENDOCRINE AND METABOLIC AGENTS: Somatropin Agents Genotropin® Genotropin MiniQuick® Norditropin® FlexPro® Humatrope® Nutropin AQ®Nuspin® Omnitrope® Saizen® Serostim® Zomacton® Zorbtive® June/July ENDOCRINE AND METABOLIC AGENTS: Antihyperglycemic, Oral Sulfonylurea, 2nd Generation Glimepiride Glipizide Glipizide ER Glyburide Glyburide Micronized Amaryl® Glucotrol® Glucotrol XL®

Glynase® PresTab® June/July

ENDOCRINE AND METABOLIC AGENTS: Insulins, Non-Analogs Humulin® N Vial Humulin® R Vial Humulin® R U-500 KwikPen®/Vial Novolin® N Vial Novolin® R Vial Humulin® N KwikPen® Novolin® N FlexPen® Novolin® R FlexPen® ReliOn® Novolin® N FlexPen®/Vial ReliOn® Novolin® R FlexPen®/Vial June/July ENDOCRINE AND METABOLIC AGENTS: Insulins, Long-Acting Lantus® SoloStar®/Vial Levemir® FlexTouch®/Vial Basaglar® KwikPen Semglee™ Toujeo® SoloStar®/Max Solostar® Tresiba® FlexTouch®/Vial June/July

(20)

ENDOCRINE AND METABOLIC AGENTS: Insulins, Mix Humalog® Mix 50/50™ KwikPen®/Vial Humalog® Mix 75/25™ KwikPen®/Vial Humulin® 70/30 Vial NovoLog® Mix 70/30 FlexPen®/Vial Humulin® 70/30 KwikPen® Insulin Aspart Protamine and

Insulin Aspart 70/30 FlexPen®/Vial Insulin Lispro Mix 75/25

KwikPen® Novolin® 70/30 FlexPen®/Vial ReliOn® Novolin® 70/30 FlexPen®/Vial June/July ENDOCRINE AND METABOLIC AGENTS: Insulins, Rapid-Acting Humalog® Cartridge/Vial NovoLog® Cartridge/FlexPen®/Vial

Admelog® SoloStar® Pen/Vial Afrezza® Cartridge Apidra® SoloStar® Pen/Vial Fiasp® FlexTouch®/PenFill®/Vial

Humalog KwikPen® Humalog® Jr KwikPen®

Insulin Aspart FlexPen®/PenFill®/Vial Insulin Lispro Jr KwikPen® Insulin Lispro KwikPen®/Vial

Lyumjev™

June/July

ENDOCRINE AND METABOLIC AGENTS:

Antihyperglycemic, Insulins, Long Acting

Analog & GLP-1 Agonist Soliqua® Xultophy® June/July ENDOCRINE AND METABOLIC AGENTS: Antihyperuricemic Agents Allopurinol Colchicine Tabs Mitigare® Probenecid Probenecid/Colchicine Colchicine Caps Colcrys® Febuxostat Gloperba® Uloric® Zyloprim® June/July ENDOCRINE AND METABOLIC AGENTS: Agents for Hypoglycemia Baqsimi® GlucaGen HypoKit® Glucagon Kit (Eli Lilly)

Glucagon Emergency Kit (gen Glucagon Kit by Eli Lilly) Glucagon Kit (Fresenius Kabi)

Gvoke® Zegalogue® Dec/Jan ENDOCRINE AND METABOLIC AGENTS: LHRH, GnRH Antagonists, Oral Orilissa® Oriahnn® June/July ENDOCRINE AND METABOLIC AGENTS: Pregnancy Maintaining Agent, Hormonal Hydroxyprogesterone Makena® Auto-Injector Makena® Vials June/July

(21)

ENDOCRINE AND METABOLIC AGENTS: Somatostatin Agents

Octreotide (gen Sandostatin®) Sandostatin® LAR Depot

Bynfezia Pen™ Mycapssa® Sandostatin® Somatuline® Depot Dec/Jan GASTROINTESTINAL: Antiemetics, 5-HT3 and NK1 Injectable Agents Fosaprepitant Ondansetron Amp/Syringe/Vial Palonosetron Vial Akynzeo® Vial Aloxi® Barhemsys® Cinvanti® Emend® Vial Granisetron Vial Palonosetron Syringe Sustol® Varubi® Vial Zofran® Vial Dec/Jan GASTROINTESTINAL: Antiemetics, 5-HT3,

NK1 & Other Select Non-Injectable Agents Aprepitant Caps Metoclopramide Soln/Tabs Ondansetron ODT/Soln/Tabs Akynzeo® Caps Anzemet® Bonjesta® Diclegis® Doxylamine/Pyridoxine Emend® Caps/Pwd Packet

Gimoti™ Granisetron Tabs Metoclopramide ODT Reglan® Sancuso® Varubi® Tabs Zofran® ODT/Soln/Tabs Zuplenz® Dec/Jan GASTROINTESTINAL: Antiemetics, THC Derivative Agents Dronabinol Cesamet® Marinol® Dec/Jan GASTROINTESTINAL: Bile Salt Agents

Ursodiol Actigall® Chenodal® Cholbam® Ocaliva® Reltone™ Urso Forte® Urso® June/July GASTROINTESTINAL: IBS-C/CIC Agents Amitiza® Linzess® Lubiprostone Motegrity™ Trulance® Zelnorm™ Dec/Jan GASTROINTESTINAL: Agents for Opioid Induced Constipation,

Opioid Antagonists

Movantik® Relistor®

Symproic®

(22)

GASTROINTESTINAL: IBS Agents,

Anti-Diarrheal Alosetron Lotronex® Viberzi® Dec/Jan GASTROINTESTINAL: Pancreatic Enzymes Creon® Zenpep® Pancreaze® Pertzye® Viokace® March/April GASTROINTESTINAL: Proton Pump Inhibitors Nexium® Rx Packet Omeprazole Rx Pantoprazole Tabs Protonix® Susp Aciphex® Aciphex® Sprinkle Dexilant™ Esomep-EZS™ Kit Esomeprazole Lansoprazole Nexium® OTC Nexium® Rx Caps Omeprazole OTC Omeprazole/Bicarb OTC/Rx Pantoprazole Susp Prevacid® Prilosec® Protonix® Rabeprazole Zegerid® Sept/Oct GASTROINTESTINAL: Ulcerative Colitis Agents, Oral Balsalazide Lialda® Pentasa® Sulfasalazine DR & IR Apriso® Asacol HD® Azulfidine® Azulfidine EN®-tabs® Budesonide (gen Uceris®)

Colazal® Delzicol® Dipentum®

Giazo®

Mesalamine (gen Apriso®) Mesalamine (gen Asacol HD®)

Mesalamine (gen Delzicol®) Mesalamine (gen Lialda®)

Ortikos™ Uceris® Tabs March/April GASTROINTESTINAL: Ulcerative Colitis Agents, Rectal

Mesalamine Kit/Supp Canasa®

Mesalamine (gen sfRowasa®) Rowasa® Enema/Kit sfRowasa® Enema Uceris® Foam March/April HEMATOLOGICAL AGENTS: Erythropoiesis Stimulating Agents (ESAs) Aranesp® Epogen® Procrit® Mircera® Retacrit® June/July

(23)

HEMATOLOGICAL AGENTS: Leukocytes (WBC) Stimulants Fulphila® Leukine® Neulasta® Onpro® Neulasta® Syringe Neupogen® Nyvepria™ Udenyca® Ziextenzo™ Granix® Nivestym™ Zarxio® June/July HEMATOLOGICAL AGENTS: Thrombocytopenia Treatment Agents NPlate® Promacta® Doptelet® Mulpleta® Tavalisse® June/July IMMUNOLOGIC AGENTS: Systemic Immunomodulators, Cryopyrin-Associated Periodic Syndrome (CAPS) Agents Ilaris® Arcalyst® Kineret® June/July IMMUNOLOGIC AGENTS: Targeted Immune Modulators, IL-6 Receptor Inhibitors

Actemra® Syringe Actemra ACTPen®/Vial Kevzara® June/July IMMUNOLOGIC AGENTS: Targeted Immune Modulators, IL-17A Antibody/IL-17 Receptor Antagonists & IL-23/IL-12 Inhibitors Taltz® Cosentyx® Ilumya® Siliq® Skyrizi® Stelara® Tremfya® June/July IMMUNOLOGIC AGENTS: Targeted Immune Modulators, JAK Inhibitors

Xeljanz® Tabs Olumiant®

Rinvoq™ Xeljanz® Soln Xeljanz® XR June/July IMMUNOLOGIC AGENTS: Targeted Immune Modulators, Select Agents Benlysta® Entyvio® Orencia® Orencia® Clickject™ Otezla® June/July IMMUNOLOGIC AGENTS: Targeted Immune Modulators TNF Inhibitors Enbrel® Humira® Cimzia® Inflectra® Remicade® Renflexis™ Simponi® Simponi ARIA® June/July

(24)

OPHTHALMIC: Antihistamines Ketotifen 10 mL OTC Olopatadine 0.2% Rx (gen Pataday®) Pazeo® Azelastine 0.05% Bepreve® Epinastine Ketotifen 5 mL OTC Lastacaft® Olopatadine 0.2% OTC Olopatadine 0.1% Pataday® Patanol® Zaditor® Zerviate™ March/April OPHTHALMIC: Dry Eye Disease Restasis® Xiidra® Cequa™

Restasis Multidose™ Sept/Oct OPHTHALMIC: Mast

Cell Stabilizers

Cromolyn Sodium Opth Alocril®

Alomide® March/April OPHTHALMIC: NSAIDS Diclofenac Flurbiprofen Sodium Ketorolac Opth Acular® Acular LS® Acuvail® Bromfenac BromSite™ Ilevro® Nevanac® Prolensa® March/April OPHTHALMIC: "Soft" Corticosteroids Durezol® Alrex® Eysuvis™ Inveltys™ Lotemax® Lotemax® SM Loteprednol March/April OPHTHALMIC: Glaucoma, Prostaglandin Agonists Latanoprost Travatan-Z® Bimatoprost Durysta™ Lumigan® Travoprost Vyzulta® Xalatan® Xelpros™ Zioptan® March/April OPHTHALMIC: Glaucoma, Rho Kinase (ROCK Inhibitors) Rhopressa® Rocklatan® March/April OPHTHALMIC: Glaucoma, Alpha 2 Receptor Agonist/ Carbonic Anhydrase Inhibitor (CAI) Simbrinza® March/April

(25)

OPHTHALMIC: Antibiotics, Fluoroquinolones Ciprofloxacin Opth Moxifloxacin (gen Vigamox®) Ofloxacin Opth Besivance® Ciloxan® Gatifloxacin 0.5% Levofloxacin 0.5% Moxeza®

Moxifloxacin (gen Moxeza®) Ocuflox® Vigamox® Zymaxid® March/April ORAL ONCOLOGY: Antiandrogenic Agents Abiraterone Xtandi® Caps Zytiga® 500mg Erleada® Nubeqa® Xtandi® Tabs Yonsa® Zytiga® 250mg Dec/Jan ORAL ONCOLOGY: Cyclin-Dependent Kinase (CDK) 4/6 Inhibitors Kisqali®

Kisqali® Femara® Co-Pack Verzenio® Ibrance® Dec/Jan OTIC PREPARATIONS: Fluoroquinolone & Combination Agents Ciprodex® Cipro HC® Ciprofloxacin Otic Ciprofloxacin/Dexamethasone Ciprofloxacin/Fluocinolone Ofloxacin Otic Otiprio® Otovel® March/April RENAL and GENITOURINARY: BPH Inhibitors Alfuzosin Doxazosin Dutasteride Finasteride 5 mg Prazosin Tamsulosin Terazosin Avodart® Cardura® Cardura® XL Cialis® 5 mg Dutasteride/Tamsulosin Flomax® Jayln® Minipress® Proscar® Rapaflo® Silodosin Tadalafil 5 mg Uroxatral® June/July RENAL and GENITOURINARY: Electrolyte Depleters, Phosphate Lowering Agents

Calcium Acetate Caps Sevelamer Carbonate Tabs

(gen Renvela®)

Auryxia® Calcium Acetate Tabs

Calphron® Fosrenol® Lanthanum Carbonate Phoslyra® Renagel® Renvela®

Sevelamer Hydrochloride (gen Renagel®)

(26)

Sevelamer Pwd Pack Velphoro® RENAL and GENITOURINARY: Electrolyte Depleters, Potassium Lowering Agents Kionex® Pwd/Susp Sodium Polystyrene Sulfonate Pwd/Susp SPS® Susp SPS® Rectal Enema Keveyis® Lokelma®

Veltassa® Pwd Pack June/July

RENAL and GENITOURINARY: Urinary Tract Antispasmodics Oxybutynin Oxybutynin ER Solifenacin Succinate Toviaz® Darifenacin ER Detrol Detrol® LA Ditropan XL® Enablex® Flavoxate Gelnique® Gemtesa® Myrbetriq® Oxytrol® Tolterodine Tolterodine ER Trospium Trospium ER Urogesic-Blue™ Vesicare® Vesicare LS™ June/July RESPIRATORY: Agents to Treat Hereditary Angioedema Berinert® Haegarda® Icatibant Takhzyro™ Cinryze® Firazyr® Kalbitor® Orladeyo™ Ruconest® Dec/Jan RESPIRATORY: Anticholinergics, Long Acting

Spiriva HandiHaler® Incruse Ellipta® Lonhala™ Magnair™ Seebri Neohaler® Spiriva Respimat® Tudorza Pressair® Yupelri® March/April RESPIRATORY: Anticholinergics,

Short Acting, & Combination Agents Atrovent HFA® Combivent Respimat® Ipratropium Soln Ipratropium-Albuterol March/April RESPIRATORY: Anticholinergics, LABA Combination Agents Bevespi Aerosphere® Stiolto Respimat® Anoro Ellipta® Duaklir® Pressair®

Utibron Neohaler® March/April

RESPIRATORY: Anticholinergics, LABA/ICS Combination Agents Breztri Aerosphere™ Trelegy Ellipta® March/April

(27)

RESPIRATORY: PDE4 Inhibitor for COPD,

Oral Daliresp® March/April RESPIRATORY: Beta-Adrenergic Agents, Long Acting

Serevent® Diskus Arcapta® Neohaler® Brovana® Perforomist® Striverdi® Respimat® March/April RESPIRATORY: Beta- Adrenergic Agonists, Short Acting, Nebulized

Albuterol Sulfate Levalbuterol Xopenex® March/April RESPIRATORY: Beta-Adrenergic Agents, Short Acting ProAir® HFA Ventolin® HFA

Albuterol HFA (gen Proair® HFA) Albuterol HFA (gen Proventil®

HFA)

Albuterol HFA (gen Ventolin® HFA) Levalbuterol HFA ProAir® Digihaler® ProAir® RespiClick® Proventil® HFA Xopenex HFA® March/April RESPIRATORY: Monoclonal Antibodies Cinqair® Fasenra® Xolair® Dupixent® Nucala® March/April RESPIRATORY: Self Injectable Epinephrines

Epinephrine 0.3mg Inj (gen Adrenaclick® & EpiPen®) Epinephrine 0.15mg Inj (gen

Adrenaclick® & EpiPen Jr.®) Symjepi® EpiPen® EpiPen Jr.® March/April RESPIRATORY: Inhaled Corticosteroids (ICS) Budesonide Respules Flovent HFA® Alvesco® ArmonAir® Digihaler™ Arnuity® Ellipta® Asmanex® HFA and Twisthaler

Flovent Diskus® Pulmicort® Flexhaler Pulmicort® Respules QVAR® Redihaler™ March/April RESPIRATORY: Inhaled Corticosteroid, Long

Acting Beta Agonist (ICS-LABA) Advair Diskus® Dulera® 100mcg/5mcg, 200mcg/5mcg Symbicort® Advair HFA® AirDuo® Digihaler™ AirDuo® Respiclick® Breo™ Ellipta™ Budesonide/Formoteral (gen Symbicort®) Dulera® 50mcg/5mcg Fluticasone/Salmeterol (gen Advair Diskus®) March/April

(28)

Fluticasone/Salmeterol (gen AirDuo®) Wixela™ Inhub™ RESPIRATORY: Intranasal Antihistamines

Azelastine 0.1% Nasal (gen Astelin®)

Azelastine 0.15% Nasal (gen Astepro®) Olopatadine Nasal Patanase® March/April RESPIRATORY: Intranasal Steroids

Fluticasone Nasal Rx Azelastine/Fluticasone Beconase AQ® Budesonide Nasal

Dymista® Flonase® Flunisolide Fluticasone Nasal OTC Mometasone Furoate

Nasacort® OTC Nasonex® Rx

Omnaris® Qnasl® Rhinocort® Allergy OTC

Rhinocort® Aqua Sinuva™ Triamcinolone Nasal Xhance® Zetonna® March/April RESPIRATORY: Leukotriene Receptor Modifiers Montelukast Accolate® Singulair® Zafirlukast Zileuton ER Zyflo® March/April RESPIRATORY: PAH-PPH Agents, Prostacyclins, IV/SQ Epoprostenol Injection Remodulin® Infusion/SQ Treprostinil Infusion Flolan® Injection

Veletri® Injection Sept/Oct

RESPIRATORY: PAH-PPH Agents, Prostacyclins, Inhaled Tyvaso® Ventavis® Sept/Oct RESPIRATORY: PAH-PPH Agents, Prostacyclins, Oral Orenitram® ER Uptravi® Sept/Oct RESPIRATORY: PAH-PPH Agents, ETRA Ambrisentan Tracleer® Bosentan Letairis® Opsumit® Sept/Oct

(29)

RESPIRATORY: PAH-PPH Agents, PDE5-I &

SGCS

Sildenafil Inj/Tabs (gen Revatio®) Tadalafil Tabs (gen

Adcirca®) Adcirca® Adempas® Alyq™ Revatio® Sildenafil Susp Sept/Oct RESPIRATORY: Antihistamines, 2nd Generation

Cetirizine Tabs OTC Cetirizine Soln Rx Levocetirizine Tabs Rx Loratadine ODT/Soln/Tabs

OTC

Allegra®

Cetirizine Caps/Chew Tabs/Soln OTC

Clarinex® Claritin® Desloratadine

Fexofenadine Levocetirizine Tabs OTC

Levocetirizine Soln Rx Loratadine Caps/Chew Tabs OTC

Quzyttir™ Xyzal® Zyrtec® March/April RESPIRATORY: Antihistamines, 2nd Generation, & Decongestant Combination Agents Cetirizine-D Loratadine-D Alavert®-D Allegra-D® Clarinex-D® Claritin-D® Fexofenadine-D Semprex®-D Zyrtec-D® March/April MISC: Methotrexate Products Methotrexate PF Vials Methotrexate Tabs/Vials Otrexup® Auto-Injector Rasuvo® Auto-Injector RediTrex® Syringe Trexall® Tabs Xatmep® Soln June/July

(30)

Date

ANTI-INFECTIVES: Antiretrovirals, Treatment Products Abacavir Abacavir/Lamivudine Atazanavir Atripla® Cimduo® Complera® Delstrigo™ Dovato® Edurant® Efavirenz Emtricitabine Evotaz® Isentress® Isentress® HD Lamivudine Lamivudine/Zidovudine Norvir® Pifeltro™ Prezcobix® Prezista® Symfi® Symfi Lo® Symtuza® Tenofovir Tivicay® Tivicay PD Triumeq® Trogarzo® Truvada® Tybost® Viread® Pwd Vocabria Abacavir/Lamivudine/ Zidovudine Aptivus® Biktarvy® Cabenuva Combivir® Crixivan® Descovy® Didanosine Efavirenz/emtricitabine/tenofovir disoproxil fumarate Efavirenz/lamivudine/tenofovir disoproxil Emtricitabine/tenofovir disoproxil fumarate Emtriva® Epivir® Epzicom® Fosamprenavir Fuzeon® Genvoya® Intelence® Invirase® Juluca Kaletra® Lexiva® Lopinavir/Ritonavir Nevirapine Odefsey® Rescriptor® Retrovir® Reyataz® Ritonavir Rukobia Selzentry® Stavudine Stribild® Sustiva® Temixys™ Trizivir® Videx® Viracept® Viramune® Viread® Tabs Zerit® Ziagen® Zidovudine Dec/Jan

(31)

PDL CLASS

Reference Products

Non-Reference Products

Review

Date

CENTRAL NERVOUS SYSTEM: Antipsychotics, Atypical (2nd Generation) Oral and Transdermal Products Aripiprazole Clozapine Fanapt® Latuda® Olanzapine Olanzapine/Fluoxetine Paliperidone ER Quetiapine Quetiapine ER Rexulti® Risperidone Saphris® Vraylar® Ziprasidone Abilify® Abilify MyCite® Asenapine (gen Saphris)

Caplyta™ Clozaril® Fazaclo® Geodon® Invega® Nuplazid® Risperdal® Secuado® Seroquel® Seroquel XR® Symbyax® Versacloz® Zyprexa® Zyprexa® Zydis® Dec/Jan CENTRAL NERVOUS SYSTEM: Antipsychotics, Atypical (2nd Generation) Depot Products Abilify Maintena™ Aristada® Aristada Initio® Invega Sustenna® Invega Trinza® Perseris™ Risperdal Consta® Zyprexa® Relprevv™ Dec/Jan

Figure

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References

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